Jim Doberman / Getty Images

HIT LIST

Who’s Screwed If Obamacare Gets the Ax?

06.27.12 8:45 AM ET

With the epochal Supreme Court decision on the Affordable Care Act coming this week, pundits and prognosticators have been working themselves into a tizzy trying to figure out who would win and who would lose in each of the 492,503 (approximately) possible directions the Roberts Court could take in its ruling.

There’s a lot at stake, from the ability of young adults to cover their chronic medical conditions to the ability of insurance companies to screw over young adults trying to live with chronic medical conditions. Here, the people who might be most screwed if the ACA gets knocked down.

Lea Roth / Getty Images

Debt-Strangled Young 20-Somethings: By design, many provisions of the Affordable Care Act were not set to trigger until years after the law’s passage in March 2010. But one of the law’s biggest changes went into effect in late September of that year: all Americans could stay on their parents’ health insurance until they turned 26. If the law is overturned, it will be up to insurance companies whether to allow this continue, and they will be under no legal obligation to do so. Many could revert to their old practice of kicking kids off their parents’ insurance plans once they turn 19. The result, particularly for young adults with expensive health conditions, could be financially ruinous.

“I have to keep a close eye on things, which requires a lot of doctors’ visits and maintenance medicines,” Liz Wilson, a 25-year-old with chronic health problems, told CNNMoney. “Without health reform, I’d really have to ask myself what I’d do.” So if the ACA falls, members of this debt-laden group will have one more thing to worry about: the tens of thousands of dollars it could cost them if they fall down on the stage and break an ankle after accepting their diplomas.

People Who Are Bad at Paperwork: Don’t laugh. Prior to the passage of the Affordable Care Act, many insurance companies were extremely trigger happy about rescinding coverage when their customers got sick. Like a persnickety English teacher, they would snatch away a sick patient’s insurance for even the slightest blunder in the application paperwork—if they thought it would save them money. As an example on the government’s pro-ACA website points out, a breast-cancer patient could have her coverage dropped for failing to mention having visited a shrink years ago. The ACA changed that by banning the practice in most circumstances. If it’s overturned, we’ll have to go back to watching what we say.

Southerners: Many consumer-protection provisions of the ACA have already been passed at the state level, and will stay in place even if the act is overturned. But a map from the Progressive States Network shows that the degree of protection varies hugely from state to state. If you live in the right state, there are laws protecting you from the whims of your insurer; if you don’t, they can bat you around like a piñata. It’s the South, as well as a good chunk of the Midwest, where health-insurance consumers appear to enjoy the fewest protections. In the absence of the ACA, the fallout could hit Texans much harder than New Englanders.

Tomas Rodriguez / Corbis

Fans of Non-Procreative Sex: Those few Americans who like having sex just for the pleasure of it (wherever you are) will be in for a surprise if Antonin Scalia and his buddies ax the Affordable Care Act. There was a recent firestorm of controversy over the ACA’s mandate that insurance plans provide free birth control, but Obama offered up a compromise shifting the burden away from religiously affiliated employers. The end result was that starting Aug. 1 the pill will be free to all American women who are insured. Without the law, many women—including those without a huge amount of disposable income—would be forced to pay for birth control out of pocket. Organizations like Planned Parenthood argue this would lead to far less consistent use of the pill—and more unplanned pregnancies.

Insurance Companies: It might come as a surprise, given that their shady practices were a large driving force behind the Affordable Care Act, but health-insurance companies aren’t necessarily rooting for SCOTUS to knock the law down. Depending on the precise nature of the ruling, they could be in for a rocky time. For example, if, as many are predicting, the court knocks down the individual mandate but keeps in place the ban on preexisting conditions, it would be a costly situation for insurance companies, who would be forced to cover sick people without the cushioning of a larger pool of enrollees provided by the mandate. “This is the one that would present us with the most and immediate concerns,” said Kimberly Kockler, vice president of government affairs at Blue Cross of Northeastern Pennsylvania, in the Wilkes-Barre Citizens’ Voice. “This would increase the risk for insurance companies, making costs astronomical.” A decision that angers consumers, Democrats, and insurance companies alike—that would be quite a feat, even by this court’s standards.